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Patient selection in ambulatory surgery
Jeremy Lermitte1, Frances Chung
1Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Insights
Ambulatory anesthesia is safe, but patients undergoing ambulatory surgery have increasing comorbidities. Outcomes require ongoing evaluation as patient populations evolve.
Area of Science:
- Anesthesiology
- Perioperative Medicine
- Surgical Outcomes
Background:
- Ambulatory surgery is increasingly utilized for diverse patient populations.
- Growing prevalence of comorbidities in patients undergoing same-day surgery.
Purpose of the Study:
- Evaluate evidence for perioperative management in ambulatory surgery.
- Focus on specific patient groups: elderly, respiratory/cardiac disease, diabetes, obesity, OSA, ex-premature infants, and children with URIs.
Main Methods:
- Systematic review of evidence.
- Analysis of perioperative management decisions.
Main Results:
- Major morbidity and mortality in ambulatory surgery are very low.
- Intraoperative cardiac events linked to hypertension and elderly status.
- Postoperative respiratory events associated with obesity, smoking, and asthma.
- Prolonged stays and readmissions often due to surgical factors or patient comorbidities.
Conclusions:
- Ambulatory anesthesia is currently very safe.
- Increasing patient comorbidities necessitate re-examination of evidence.
- Ongoing monitoring of outcomes is crucial as patient demographics shift.
Purpose Of Review:
To evaluate the evidence regarding decisions made in the perioperative management of patients undergoing ambulatory surgery for the following: the elderly, hyper-reactive airways disease, coronary artery disease, diabetes, obesity, obstructive sleep apnea, the ex-premature infant and the child with an upper respiratory infection.
Recent Findings:
Major morbidity and mortality following ambulatory surgery is exceedingly low. Minor adverse cardiac events during the intraoperative period are associated with hypertension and the elderly. Minor adverse respiratory events during the intraoperative period are associated with obesity. Respiratory events during the postoperative period are associated with obesity, smoking and asthma. Prolonged stays following ambulatory surgery are predominantly caused by surgical factors or minor symptoms such as pain or nausea. Surgical factors are also the main causes of unplanned admissions. Age greater than 85, significant co-morbidity and multiple admissions to hospital in the 6 months preceding ambulatory surgery, however, are associated with higher readmission rates.
Summary:
Evidence indicates that ambulatory anesthesia is currently very safe. Ambulatory surgery, however, is being offered to a population with increasing co-morbidity. As the population undergoing ambulatory surgery changes over time, the evidence regarding patient outcomes will need re-examination.
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